Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Clinical Metabolism, Late-stage Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
Int J Obes (Lond). 2021 Mar;45(3):535-546. doi: 10.1038/s41366-020-00707-z. Epub 2020 Nov 7.
Bariatric surgery reduces incidence of albuminuria and end-stage renal disease in patients with obesity. Effects of bariatric surgery on long-term remission and progression of pre-existing obesity-related renal damage are mainly unexplored. Here we investigate the long-term effects of bariatric surgery compared with conventional obesity care on remission and progression of albuminuria.
4047 patients were included in the Swedish Obese Subjects study. Inclusion criteria were age 37-60 years, BMI ≥ 34 kg/m in men and BMI ≥ 38 kg/m in women. Our analysis comprised 803 patients (19.8% of total population, 357 control, 446 surgery) with pre-existing albuminuria including 693 patients (312 control, 381 surgery) with microalbuminuria, and 110 patients (45 control, 65 surgery) with macroalbuminuria. Surgery patients were treated with banding, vertical banded gastroplasty, or gastric bypass. Control patients received conventional obesity care.
Total urinary albumin excretion was 36.5% lower in all patients with albuminuria after 15 years, 44.5% lower in patients with microalbuminuria after 15 years, and 27.8% lower in patients with macroalbuminuria after 2 years following bariatric surgery compared with conventional care. In surgery patients with microalbuminuria, remission to normoalbuminuria was higher (OR, 5.9, 2.2, 3.2, p < 0.001) and progression to macroalbuminuria was lower (OR, 0.28, 0.26, 0.25, p ≤ 0.02) at 2, 10, and 15 years, respectively, compared with control patients. In surgery patients with macroalbuminuria remission to normo- or microalbuminuria was higher (OR, 3.67, p = 0.003) after 2 years. No differences between surgery and control patients with macroalbuminuria were observed after 10 and 15 years. Surgery slowed progression of eGFR decline after 2 years in patients with microalbuminuria and macroalbuminuria (treatment effect: 1.0 ml/min/1.73 m/year, p = 0.001 and 1.4 ml/min/1.73 m/year, p = 0.047, respectively).
Bariatric surgery had better effects than conventional obesity care on remission of albuminuria and prevention of eGFR decline, indicating that patients with obesity-related renal damage benefit from bariatric surgery.
减重手术可降低肥胖患者的白蛋白尿和终末期肾病的发生率。减重手术对长期缓解和进展的预先存在的肥胖相关肾损害的影响主要尚未可知。在此，我们研究了与常规肥胖治疗相比，减重手术对白蛋白尿的缓解和进展的长期影响。
4047 名患者纳入了瑞典肥胖受试者研究。纳入标准为年龄 37-60 岁，男性 BMI≥34kg/m，女性 BMI≥38kg/m。我们的分析包括 803 名患者（总人群的 19.8%，357 名对照，446 名手术），他们存在预先存在的白蛋白尿，其中 693 名患者（312 名对照，381 名手术）存在微量白蛋白尿，110 名患者（45 名对照，65 名手术）存在大量白蛋白尿。手术患者接受束带、垂直束带胃成形术或胃旁路手术治疗。对照组患者接受常规肥胖治疗。
所有白蛋白尿患者在 15 年后的总尿白蛋白排泄量降低了 36.5%，微量白蛋白尿患者在 15 年后降低了 44.5%，大量白蛋白尿患者在 2 年后降低了 27.8%。与常规治疗相比，手术后的微量白蛋白尿患者，缓解至正常白蛋白尿的比例更高（OR，5.9、2.2、3.2，p<0.001），进展为大量白蛋白尿的比例更低（OR，0.28、0.26、0.25，p≤0.02），分别在 2 年、10 年和 15 年时。术后大量白蛋白尿患者缓解至正常或微量白蛋白尿的比例更高（OR，3.67，p=0.003），2 年后。在 10 年和 15 年后，手术与对照组患者在大量白蛋白尿患者之间未观察到差异。术后 2 年，微量白蛋白尿和大量白蛋白尿患者的 eGFR 下降速度均减缓（治疗效果：1.0ml/min/1.73m/年，p=0.001 和 1.4ml/min/1.73 m/年，p=0.047）。
与常规肥胖治疗相比，减重手术对白蛋白尿的缓解和 eGFR 下降的预防效果更好，这表明肥胖相关肾损害患者受益于减重手术。
